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Posted: December 15, 2004

Professional Caregiving

Providing an Expanded Community Care Package for Seniors

Did you know that in 2001, Medicare rules changed to allow home health services to be authorized in conjunction with adult day care?

Because many home health providers are not yet aware of the change, the adult day services industry is interested in initiating forums to bring together professionals from both industries. The purpose is to bridge two industries that have up until 2001 been kept from providing services simultaneously to frail seniors who had both in-home care needs and adult day care needs.

Approximately 15 agencies began a project here in St. Louis a number of years ago which had inter-agency collaboration as the goal, so that our clients, whether in adult day or home health, would learn the benefits of the other service to complement the one they were already receiving. We had been meeting monthly to coordinate and educate each other in the mutual benefits of a combined package to include both adult day care and in home services.

Many professionals, and therefore many potential users, don?t realize that home health services can now be complemented by another service which ensures that socialization, nursing, therapies, supported transportation and meals are provided.

Adult day care and in-home health care have a shared primary goal to prevent or delay unnecessary nursing home placement. Adult day care is different from in-home health care because it is provided in a setting outside of the home. Adult day care participants attend the center one to five days each week and enjoy the company of others who, like themselves, might have had a medical setback but who still want, and need, peer interaction, a safe way to get out of the house, and an environment that provides supports like nursing, assistance with activities of daily living and meals. Due to recent changes in Medicare?s definition of ?homebound? status, adult day care and in-home health are now positioned to be working in tandem.

While some adult day care and in-home health services overlap (in the nursing, social work and therapy arenas) they each have distinct services to offer as well. Both industries can provide a more comprehensive service package to seniors, giving them the benefits of the privacy of in-home, one-on-one care along with the socialization and assistance out of the house that adult day care can offer. If in-home health clients seek a daytime program with social and recreational activities, they will maintain their health and remain in their home for a longer period of time.

The following scenario was common before the rule change:

Joe Reed, 75 years old, had a stroke. He was hospitalized, and when he made enough progress to go home, he was discharged under the care of a home health provider who would visit Joe three times a week to provide therapy and nursing services, including bathing and personal care.

While Joe was safe living at home, his stroke kept him from getting out as easily as he had been able to. As weeks turned into months, his mood decreased and he became depressed. Medicare would not simultaneously authorize adult day care for his socialization needs which were not being met throughout his recuperation period.

Therapy, personal care, and nursing services were necessary, but so were socialization and daily nursing monitoring that could be done in an adult care and enrichment program.

Why couldn?t Joe take advantage of these two community based services? It could be economics: Before July 2001, Medicare would not reimburse the home health provider if he went to an adult day care program at the same time.

Combining daily nurse monitoring, meals, transportation, therapies and social work in a socially stimulating environment in addition to nursing services provided in the privacy of one?s own home is truly the package of choice. Family members recovering from a medical setback need both in-home and outside services to maintain optimal health.

Some adult day centers in town have called clients? families to survey their in home care needs so that appropriate referrals can be coordinated to help clients maintain their highest level of functioning. The in-home industry is doing likewise, and will be referring their isolated in-home patients to local day centers, hoping to help them avoid the disabling effects of depression that come from minimal social interaction.

Adult day and in-home programs can be the package of choice for many seniors who are still living in their homes. Consider developing a network of providers in your town for the benefit of your community-dwelling seniors.


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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